Implementation of a synoptic operative note for abdominal wall hernia repair: a statewide pilot evaluating completeness and communication of intraoperative details.

BACKGROUND: Variable approaches to intraoperative communication impede our understanding of surgical decision-making and best practices. This is critical among hernia repairs, where improved outcomes are reliant on understanding the impact of different patient characteristics and surgical approaches. In this context, a hernia-specific synoptic operative note was piloted as part of an effort to create a statewide hernia registry. We aimed to understand the impact of the synoptic operative note on variable missingness and evaluate barriers and facilitators to improved intraoperative communication and note adoption. METHODS: In January 2020, the Michigan Surgical Quality Collaborative (MSQC) registry was expanded to capture hernia-specific intraoperative variables. A synoptic operative note for hernia repair was piloted at 8 hospitals. The primary outcome was change in hernia variable communication, measured by missingness. Using a sequential explanatory mixed-methods design, we performed semi-structured interviews with data abstractors (n = 4) and surgeons (n = 4) at 5 pilot sites to assess barriers and facilitators of implementation. Interviews were iteratively analyzed using content analysis with both deductive and inductive approaches. RESULTS: From January to June 2020, 870 hernia repairs were performed across 8 pilot and 53 control sites. Pilot sites had significantly less missingness for all hernia-specific variables. At pilot sites, 46% of notes were fully complete in regard to hernia variables, compared to 21% at control sites (p value < 0.001). While collection of intraoperative variables improved after synoptic note implementation, low note adoption was reported. Facilitators of improved variable collection were (1) communication with data abstractors and (2) stakeholder acknowledgment of widespread benefit, while barriers included (1) surgeon resistance to practice change, (2) EMR/technology, and (3) interruptions to communication and implementation. CONCLUSION: This mixed-methods evaluation of a synoptic operative note implementation suggests that sustained communication, particularly with abstractors, was the most impactful intervention. Future implementation efforts may have improved effectiveness with interventions supplementary to surgeon-level direction.

Women Surgeons' Perspectives on System-level Strategies to Address Interpersonal Workplace Conflict.

OBJECTIVE: We sought to gain a comprehensive understanding of the current methods for conflict resolution and the ways in which women surgeons would prefer workplace conflicts to be adjudicated. SUMMARY OF BACKGROUND DATA: Interprofessional workplace conflicts are poorly studied, particularly for women in surgery. These conflicts may negatively impact surgical team dynamic and be detrimental to patient safety. Moreover, workplace conflicts and their management are a proposed driver of decreased professional satisfaction and achievement. How women surgeons experience workplace conflicts and how these are managed remains unexplored. METHODS: We conducted 30 semi-structured interviews with women surgeons across the United States who had experienced workplace conflict that resulted in action by a nonphysician. Surgeons were diverse with respect to demographics, specialty, and institutional settings. Through thematic analysis using NVivo, we analyzed and reported patterns within the data. RESULTS: Although the majority of women asserted resilience in how they engage with these situations, many also cited ways in which these events could better be adjudicated. Recommendations included (1) more direct conflict resolution, (2) more transparency in reporting processes, (3) greater opportunity to address complaints, (4) explicit policies for events that repeatedly result in workplace conflict, and (5) divorcing interpersonal complaints from patient safety reporting mechanisms. CONCLUSION: This study motivates and informs best practices around adjudication of workplace conflict to help protect women surgeons and nonclinicians. Going forward, best practices should include more objective criteria for how conflicts are adjudicated. Continued efforts at an institutional level are needed to help mitigate inequities against women surgeons.